American Academy of Pediatrics Offers Interim Guidance on Children’s Emotional and Behavioral Health During the COVID-19 Pandemic; Child Care Interim Guidance is Updated

Pediatricians can work with families to identify concerns, build on children’s strengths, and access resources

The COVID-19 pandemic has exhausted families and upended routines, posing new challenges for children and adolescents who are struggling with existing or emerging behavioral and emotional health issues. Yet children are resilient, especially when they have the right supports in place.

To make sure children’s needs do not go undetected during this tumultuous time, the American Academy of Pediatrics has released new interim guidance on” Supporting the Emotional and Behavioral Health Needs of Children, Adolescents and Families During the COVID-19 Pandemic.”

“As a pediatrician, I know that children don’t always know how to express their true feelings and they may even try to protect their parents from added worries rather than share when something is wrong,” said AAP President Sally Goza, MD, FAAP. “This is one reason we want to see your children and teens during office visits, not just to stay up to date on immunizations, but to check on their social and emotional health, too.”

Families of color have been especially vulnerable during the pandemic because of structural inequities caused by racism that affect access and quality healthcare, food security, employment, housing and education. Pediatricians evaluating the impact of COVID-19 on a child’s social, emotional and behavioral health recognize these added stressors on a family and can help identify community resources and services for help.

“Children – especially those with special health care needs - may be struggling to learn remotely and missing the in-person attention of teachers and specialists they would normally see at school,” Dr. Goza said. “Some families may not have access to the internet. The pandemic’s impact has exacerbated whatever challenges already existed.”

The AAP guidance describes how children and adolescents may behave differently when under stress, and how those signs vary by age and stage. For instance, infants and young children may demonstrate their distress through disruptions of functions like sleep, toileting and feeding. Older children and adolescents may show signs of withdrawal, fearfulness and anxiety; or show externalizing behaviors such as oppositionality, irritability, argumentativeness, aggression; or show symptoms such as abdominal pain or headaches.

The AAP recommends:

• Pediatricians are experts in screening and assessing children for developmentally appropriate behaviors. During the COVID-19 pandemic, it is especially important that pediatricians continue to advise families about emotional and behavioral responses and needs in the context of typical development.
• It is not uncommon for children to have developmental regression during times of stress.
• Caregivers should be encouraged to have open and honest conversations with their children and adolescents about what they are hearing in the media. Avoidance of such conversations does not protect children.
• Older children and adolescents may find the social isolation related to the pandemic overwhelming. Socializing with peers is a mainstay of child and adolescent development. Following local, state and national guidelines for physical distancing and reopening should remain an urgent priority while families help find paths for youth to socialize safely.
• Parents and caregivers should explain to children and adolescents that screen time has its benefits as well as real risks. Families should be selective in choosing media, but for the time being, know media is being used more for education and socialization.
• Pediatricians can remind families about the strength they provide for their children by being present, empathic and nurturing. Practicing techniques together such as mindfulness, relaxation, and focusing on the present moment can help the entire family build coping skills to deal with uncomfortable and frightening feelings.
• Children and teens can be encouraged to explore their creativity, passions, and strengths to help others, volunteer and contribute to their community. Reframing and taking control of small things such as making their own masks or participating in volunteer opportunities to help the community can help children and caregivers feel less vulnerable.

“Children and adolescents often serve as ‘emotional barometers’ for their family because they reflect the level of stress that parents and caregivers may be experiencing,” Dr. Goza said. “Children pick up on the cues of the adults. Now is the time for us to be mindful of the stresses that we are all experiencing, and to not be afraid to ask for help.”

The guidance can be found here.

For parents, see HealthyChildren.org articles here:

• Mental Health During COVID-19: Signs Your Child May Need More Support
• Parenting in a Pandemic: Tips to Keep the Calm at Home

To request an interview, contact AAP Public Affairs.

American Academy of Pediatrics Updates Interim Guidance on Child Care

The American Academy of Pediatrics has updated its interim guidance on child care during the COVID-19 pandemic based on what is currently known about the transmission and severity of coronavirus disease. The “Guidance Related to Child Care During COVID-19,” aims to reduce risk of exposure and spread of infection to staff, children and families of early care and education programs. The guidance details primary prevention practices, such as immunizations, well child care and special consideration for children with special health care needs. The updated guidance emphasizes that decisions for early care and education, such as dismissals, event cancellations, and physical distancing measures be made locally, in collaboration with local health officials. Detailed recommendations and resources are offered to help child care facilities improve safety through hygienic practices, cleaning, ventilation and other infection disease measures. The AAP advises that children remain home when showing symptoms of illness and recommends that child care programs develop a plan for what to do if a child becomes sick during the day. For more, find the guidance here.

For parents, see this HealthyChildren.org article:

Ask the Pediatrician: Is it safe to send my child to child care during COVID-19?

To request an interview, contact AAP Public Affairs. A downloadable graphic that contains a checklist of symptoms for parents is also available for media’s use, upon request.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.